Pulmonary venous hypertension

Pulmonary venous hypertension may be caused by mediastinal lesions which compress the pulmonary veins, a myxoma or ball-valve thrombus in the left atrium, mitral or aortic valve disease, or left ventricular failure. It may also result from pulmonary veno-occlusive disease.

An acute increase in pressure in the pulmonary venous system results in pulmonary congestion and a corresponding increase in pulmonary artery pressure. If the congestion is severe, pulmonary oedema may result. Chronic increases in venous pressure may lead to pathological changes in the lung but, in contrast to those produced by increases in precapillary pressure, they affect the whole of the pulmonary vasculature. The pulmonary veins and venules show medial hypertrophy, arterialisation, dilatation, and eccentric intimal fibrosis. The microcirculation is characterised by capillary congestion, oedema, dilatation of interstitial and pleural lymphatics, and alveolar haemosiderosis. Pulmonary arterioles are often muscularised and both muscular and elastic arteries may be dilated.76

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